Healthcare Provider Details

I. General information

NPI: 1730943119
Provider Name (Legal Business Name): TORI GORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD STE 209
PLACENTIA CA
92870-3760
US

IV. Provider business mailing address

49495 RANCHO SAN FRANCISQUITO
LA QUINTA CA
92253-8441
US

V. Phone/Fax

Practice location:
  • Phone: 714-831-1844
  • Fax:
Mailing address:
  • Phone: 760-702-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: